Schizophrenic disorders are characterized by psychosis, which is a loss of contact with reality and can include hallucinations, delusions, and disorganized thinking and behavior. Mood disorders, on the other hand, are characterized by disturbances in the regulation of mood, such as depression or mania. While both can cause significant distress and impairment, schizophrenia is a more severe disorder with more disabling symptoms. Mood disorders can often be managed with medications and psychotherapy, while schizophrenia may require a combination of medications, psychotherapy, and other interventions.
Comparison of bipolar disorder and schizophrenia
Schizophrenia is a primary disease psychotic disorderconsidering that bipolar disorder is a primary illness mood disorder which may also involve psychosis. Both schizophrenia and bipolar disorder are characterized as critical psychiatric disorders at the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5). However, because of some similar symptoms, differentiating between the two can sometimes be difficult; in fact, there is an intermediate diagnosis called schizoaffective disorder.
Although reported and observed symptoms are the main way to diagnose any disorder, recent studies use advanced technology such as MRI image (MRI) to try to understand the biology of mood and psychotic disorders. Using MRIs, psychiatrists can see specific structural differences in the brains of people with schizophrenia and bipolar disorder. These differences include gray matter volume, variations in neuropathological differences in cortical size and thickness, which are associated with cognitive differences on tests. These differences can sometimes be seen over the lifetime of illnesses and usually occur shortly after the initial episode.
In the treatment of bipolar disorder and schizophrenia, there are several paths that psychiatrists and psychologists follow, some are similar and some are different. However, there are some conflicts regarding medical and therapeutic treatments considering the long-term effects and relapse issues in treating both disorders.
Cause and epidemiology
Both bipolar disorder and schizophrenia appear to result from gene-environment interaction. Evidence from numerous family and twin studies indicates a shared genetic etiology between schizophrenia and bipolar disorder. The researchers found a combined heritability for bipolar disorder and schizophrenia of approximately 60%, with environmental factors accounting for the remainder. Genetic contributions to schizoaffective disorder appear to be fully shared with those contributing to schizophrenia and mania.
Bipolar I disorder and schizophrenia each occur in approximately 1% of the population; it is estimated that schizoaffective disorder occurs in less than 1% of the population.
Schizophrenia is caused by a combination of genetic and environmental factors. Research shows that schizophrenia is hereditary and is more likely to strike those who carry certain genes. Those who are susceptible to the disorder are believed to be affected by something in their environment. According to research, alteration in concentrations of specific chemicals in the brain may also contribute to schizophrenia. Among the 1% of the population affected by this disorder, it is recorded that men are more susceptible than women to be affected. The disorder usually shows symptoms during adolescence.
There is no conclusive evidence on what triggers it, but genetic and environmental factors are being considered as likely causes. It is believed that genetic factors contribute to its development. However, not everyone with a family history of bipolar disorder develops the disorder. According to research, people with specific genes are more likely to develop the disorder. Stress, for example, can also precipitate the onset of bipolar disorder.
Signs and symptoms
Patients with schizophrenia have abnormal brain activities that include changes in brain structure or function and abnormal levels of neurotransmitters. These changes may be associated with abnormal social or emotional functioning.
To be exact, patients with schizophrenia lose gray matter volume in both hemispheres of the brain, specifically in the left thalamus and right caudate. Furthermore, gray matter loss extends to the brain, parahippocampal gyrus, and hippocampus. However, gray matter increases in the temporal and parietal lobes along with the anterior cerebellum. The only region where volume increases for gray matter is within the right cerebellum, an area that contributes to the cognitive, affective, perceptual, and other deficits seen in schizophrenia.
MRI studies have found that schizophrenia is associated with amygdala volume compared to healthy controls.
It includes withdrawal from social interaction, disorganized speech or behavior, and abnormal motor behaviors. Disorganized speech can include rambling, incoherence or abrupt change of subject. People who have schizophrenia may also experience delusions or hallucinations. Delusions are false beliefs not supported by evidence – for example, believing that you are being followed or watched or that you have special abilities or powers. Hallucinations are the perception of seeing, hearing or feeling things that are not present.
Unlike schizophrenia, bipolar disorder has few differences in gray matter volume. Overall, there is no difference in brain tissue volumes between bipolar patients and healthy control patients.
However, some research has observed that patients with mood disorders have abnormalities, including cortical tissue and subcortical regions of the brain. Left anterior lesions, cortical or subcortical, predict high level of depression in patients suffering from mood disorders. Both the left cortical and the subcortical showed a significant relationship between the severity of depression and the location of the lesion in relation to the frontal lobe.
Behavioral symptoms of patients with bipolar disorder include changes in mood, activity levels and behavior. Patients with bipolar disorder can be delighted during a manic episode and extremely sad during a depressive episode. They may also experience changes in their activity level. They can be highly active during a manic episode and extremely inactive during a depressive episode and exhibit behavioral changes. They may engage in behaviors that they would not normally have during a manic episode, such as overspending.
While there is no cure for either condition, effective treatments can help people manage their symptoms and live productive lives.
Most treatments are designed to manage symptoms and make them more tolerable due to low complete remission rates for both disorders and poorly understood and poorly researched mechanisms of change. Treatments for these disorders include medications, psychotherapy, rehabilitationand electroconvulsive therapy.
Medication is the cornerstone of treatment for both bipolar disorder and schizophrenia. Antipsychotic medications are the most commonly prescribed for both conditions. Antipsychotics work by helping to regulate levels of certain chemicals in the brain that are involved in mood and thinking. In addition, mood stabilizers such as lithium are the main drug treatment for bipolar disorder.
Additionally, second-generation antipsychotic medications (dopamine antagonists and serotonin antagonists) may also be used for bipolar disorder, often in combination with antidepressant medications (which often increase the availability of serotonin). Antipsychotics (usually second-generation, but also first-generation) are the main class of drugs used to treat schizophrenia.
Common side effects of antipsychotic medications include dry mouth, weight gain, drowsiness and constipation. Some antipsychotic drugs can also cause a temporary worsening of symptoms known as akathisia.
Psychotherapy is a treatment for patients with both disorders. They guide patients in their thoughts and use communication or behavioral work as a means of healing. The most common and effective type of therapy is cognitive behavioral therapy (CBT), which can help people manage their symptoms and improve their overall functioning. It helps people identify and change negative patterns of thinking and behavior. CBT is used to treat bipolar disorder and schizophrenia.
Families of those affected also benefit from this treatment, as they can also participate in the sessions and talk with the therapist. Another type of therapy that may be helpful for people with bipolar disorder and schizophrenia includes family therapy, psychoeducation, and support groups.
Rehabilitation it is one of several psychosocial treatments for schizophrenia. It involves social and job skills training to improve an individual’s ability to function in society.
electroconvulsive therapy (ECT) can be used to treat bipolar disorder when other treatments are ineffective or when medication could be dangerous because of another medical condition.
- This article incorporates text from a scholarly publication published under a copyright license that allows anyone to reuse, revise, remix, and redistribute the materials in any form for any purpose: Cosgrove & Suppes 2013. Please check the source for exact licensing terms.
- This article incorporates public domain material websites or documents National Institute of Mental Health.
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